Ketamine Wellness Institute of Jacksonville Beach, LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

KETAMINE WELLNESS INSTITUTE OF JACKSONVILLE BEACH, LLC

Practice address

1361 13TH Ave S Ste 140
Jacksonville Beach, FL 32250-3263

Phone

(904) 373-8153

NPI assigned

Sep 25, 2024

Last updated

Sep 25, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sathavaram Reddy, MD

Title

Owner

Phone

(904) 373-8153

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1487471918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S STE 140",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503263",
            "telephone_number": "904-373-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S STE 140",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503263",
            "telephone_number": "904-373-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS INSTITUTE OF JACKSONVILLE BEACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "SATHAVARAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-373-8153",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina Kaufman, M.A.
• Jeffrey Ross Keener, CPO/LPO
• Abby Rae Kelly
• Vanessa Kelly, LMT
• Michael H Kessler, D.D.S.
• Lisa Kidd, NP
• Judith Ann Killeen, ARNP
• Aaron Kindsvatter, PH.D. LMHC
• Maxwell Clark King II, B.PH.
• Anneline Kingsley, M.D.

• Interventional Pain Medicine Physician in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.